Posted 10/1/2024 Updated 11/01/2024
What’s changing?
Effective Jan. 1, 2025, Alacura Medical Transportation Management will manage air and ground medical transportation, prior authorization, recommended clinical review and retrospective claim reviews for certain fully insured and Administrative Services Only groups*. Members of the fully insured account group #212824 will not use Alacura to manage these services. Medical Management at Blue Cross and Blue Shield of Texas will no longer manage these services as of 11:59 pm on Dec. 31, 2024.
*Alacura does not manage:
- BCBSTX Medicare Advantage and BCBSTX Medicaid
- 911/scene of accident or residence-based pickups
Alacura manages:
- Air (Interfacility transfer for both fixed wing and rotor flights)
- Ground (reviewing level of care from basic life support to advance life support and urgency level for emergency and non-emergency transportation)
- Easy workflows and simple administrative processes to help with locating available ambulances, beds at the receiving hospital and other logistics of your patient’s transport
- Assurance that members are transported by an in-network provider where possible while proving cost effectiveness of member benefits.
For more information and a full list of codes refer to the Prior Authorization Services for Fully Insured members and certain Administrative Services Only groups and the Recommended Clinical Review Options as follows:
- Prior Authorization Services List for Other ASO Groups Effective 01/01/2024
- Prior Authorization Procedure Codes List for Other ASO Plans Effective 01/01/2025
- 2024 Recommended Clinical Review, Post Service Review and Non-Covered Procedure Code List for Fully Insured Accounts (Includes Services Effective 01/01/2025)
What do I need to do?
Facilities and providers need to contact Alacura immediately once the transport decision is made. Ambulance providers will want to check that Alacura has been engaged for patient facility transports before picking up the patient to ensure transport will be approved. Nurses are available 24/7/365 for real-time verbal assessments.
How do I contact Alacura effective Jan. 1, 2025?
- By phone (quickest channel) at 866-671-4834
- By fax at 866-671-4995
- Online at https://alacura.my.site.com/preauth/s/
- By email at Texas.UM@alacura.com
Check Eligibility and Benefits
Providers should check eligibility and benefits through Availity® Essentials or their preferred vendor. This may also indicate if a service requires a prior authorization, recommended clinical review. or retrospective review.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
Continue to watch News and Updates for future program updates and training opportunities.
Checking of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.
Alacura Medical Transportation Management, LLC. is an independent company that has contracted with Blue Cross and Blue Shield of Texas to provide utilization management services for members with coverage through BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services they offer.